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EBM

CRITICAL APPRAISAL

Disusun oleh :

Nidya Annisa Putri (11001!11"

Tetty Prasetya Ayu Lestari (1101!#!"

Dosen Pe$%i$%in& :

dr' Aditarah$a I$anin&dyah

FAKULTAS KEDOKTERAN

 UNIVERSITAS YARSI

2015/2016

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Senario

Seorang perempuan u!a "0 #a$un %a#ang &e ruma$ a&!# un#u& &on#ro' . (a!en

a%a'a$ pen%er!#a Sistemic Lupus Ertimatous )SLE* e'ama 2 #a$un+ (a%a pemer!&an

,!!& %! %apa#&an u$u -.5o &onung#!a pu3a# #er%apa# ar!a4an %! mu'u# %an pa%a

4aa$ #er%apa# malar rash.a!' pemer!&aan 'aora#or!um %!%apa#&an &a%ar D-  10ng/m'+ (a!en

menan7a&an apa&a$ a%a $uungan an#ara meng&onum! &or#!&o#ero!% %engan &a%ar 

!#am!n D- 7ang ren%a$8

)ore&round *uestion

Apa $uungan an#ara pen7a&!# SLE %engan %e,!!en! !#am!n D-  pa%a pa!en

#ereu#8

PIC+

(9 (erempuan pen%er!#a SLE

I 9 Ka%ar D- menurun9 Ka%ar D- men!ng&a#

O9 (enurunan &a%ar !#am!n D- pa%a SLE

Pen,arianButiIl$iah

-ey.ord 9 SLE An% V!#am!n 25)O*D AND :O;AN AND

DEFIIENY

Sour,e/data%ase 9 n3!+n'm+n!$+go

Li$itation 9 2011 < 2016

Result 9 1"

1+ ita$in D  An#!o%!e !n S7#em!3 S3'ero! (a#!en#9 F!n%!ng an% '!n!3a'

orre'a#!on+

2+ ita$in D  preen# en%o#$e'!a' %amage !n%u3e% 7 !n3reae% neu#rop$!'

e=#ra3e''u'ar #rap ,orma#!on !n pa#!en# 4!#$ 7#em!3 'upu er7#$ema#ou+

-+ ita$in D  'ee' !n In%!an 7#em!3 'upu er7#$ema#ou pa#!en#9 ao3!a#!on

4!#$ %!eae a3#!!#7 !n%e= an% !n#er,eron a'p$a+

"+   >$7%ro=7!#am!n D an% 3ar%!oa3u'ar %!eae !n pa#!en# 4!#$ 7#em!3

'upu er7#$ema#ou9 %a#a ,rom a 'arge !n#erna#!ona' !n3ep#!on 3o$or#+

5+ ita$in D  de2i,ien,y  %oe no# pre%!3# progre!on o, 3oronar7 ar#er7

3a'3!um 3aro#!% !n#!ma>me%!a #$!3&ne or $!g$>en!#!!#7 >rea3#!e pro#e!n!n 7#em!3 'upu er7#$ema#ou+

6+ ita$in D  !n 7#em!3 'upu er7#$ema#ou9 mo%e# ao3!a#!on 4!#$ %!eae

a3#!!#7 an% #$e ur!ne pro#e!n>#o>3rea#!n!ne ra#!o+

.+ Re#ora#!on o, regu'a#or7 an% e,,e3#or T 3e'' a'an3e an% ? 3e'' $omeo#a! !n

7#em!3 'upu er7#$ema#ou pa#!en# #$roug$ 3ita$in D  upp'emen#a#!on+

@+  >7%ro=7!!#am!n D- 'ee' !n pa#!en# 4!#$ 7#em!3 'upu er7#$ema#ou

an% !# ao3!a#!on 4!#$ 3'!n!3a' parame#er an% 'aora#or7 #e#+

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+ (rema#ure a#$ero3'ero! ! ao3!a#e% 4!#$ $7po!#am!no! D an%

ang!o#en!n>3oner#!ng enB7me !n$!!#or non>ue !n 'upu pa#!en#+

10+ Re%u3e% erum 3on3en#ra#!on o,  >$7%ro=7 3ita$in D  !n Eg7p#!an pa#!en#

4!#$ 7#em!3 'upu er7#$ema#ou9 re'a#!on #o %!eae a3#!!#7+

11+  >7%ro=7!#am!n D de2i,ien,y  ! ao3!a#e% 4!#$ !n3reae% aor#!3 #!,,ne

!n pa#!en# 4!#$ 7#em!3 'upu er7#$ema#ou+

12+ D!eae a3#!!#7 pro#e!nur!a an% 3ita$in D  #a#u !n 3$!'%ren 4!#$ 7#em!3

'upu er7#$ema#ou an% uen!'e %erma#om7o!#!+

1-+ ita$in D  'ee' !n $!nee pa#!en# 4!#$ 7#em!3 'upu er7#$ema#ou9

re'a#!on$!p 4!#$ %!eae a3#!!#7 a3u'ar r!& ,a3#or an% a#$ero3'ero!+

1"+ ita$in D  de2i,ien,y  ! ao3!a#e% 4!#$ an !n3reae% au#o!mmune repone !n

$ea'#$7 !n%!!%ua' an% !n pa#!en# 4!#$ 7#em!3 'upu er7#$ema#ou+

Sele,ted arti,le

 >7%ro=7!!#am!n D- 'ee' !n pa#!en# 4!#$ 7#em!3 'upu er7#$ema#ou an% !#

ao3!a#!on 4!#$ 3'!n!3a' parame#er an% 'aora#or7 #e#+

REIE4 56RNAL

Ba,&round:

Some #u%!e $ae '!n&e% !#am!n D !nu,,!3!en37/%e,!3!en37 4!#$ eera'

au#o!mmune %!eae u3$ a !nu'!n %epen%en# %!ae#e me''!#u mu'#!p'e 3'ero!

!n,'amma#or7 o4e' %!eae an% SLE+ T$u !#am!n D !nu,,! 3!en37/%e,!3!en37 !

ugge#e% #o e an e=#r!n!3 ,a3#or 3apa'e o, mo%!,7!ng #$e prea'en3e o, 

au#o!mmune %!eae u3$ a SLE an% !n#er,er!ng 4!#$ #$e!r eer!#7+

Metode:

ro>e3#!ona' prope3#!e #u%7 per,orme% a# #$e SLE '!n!3 Depar#men# o, R$euma#o'og7 op!#a' %a '!n!3a Un!er!%a%e Fe%era' %e (ernamu3o 4!#$

3onen!en3e amp'!ng !n3'u%!ng .@ pa#!en# 4!#$ SLE an% 6" o'un#eer )3ompar!on

group* ma#3$e% 7 gen%er an% age

Result:

Inu,,!3!en37/%e,!3!en37 o, 25)O*D 4a ,oun% !n "5 )5.+.C* pa#!en# 4!#$ SLE an%

25 )-C* !n%!!%ua' !n #$e 3ompar!on group+ T$e mean erum 'ee' o, 25)O*D

4ere 2+- ng/mL )6+1<55+2 ng/mL* !n pa#!en# 4!#$ SLE an% --+12 ng/mL )15+<6-+@

ng/mL* !n #$e 3ompar!on group an% #$! %!,,eren3e 4a #a#!#!3a''7 !gn!,! 3an# )(

0+0"1*+ No #a#!#!3a''7 !gn!,! 3an# %!,,eren3e 4a oere% e#4een #$e mean age o, 

 o#$ group+ No #a#!#!3a''7 !gn!,! 3an# ao3!a#!on 4a oere% e#4een 25)O*D

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!nu,,! 3!en37/%e,!3!en37 an% #$e ,o''o4!ng9 #!me #o %!agno! %!eae a3#!!#7

)SLEDAI 6* ,a#!gue ue o, 3or#!3o#ero!% an% an#!ma'ar!a' an% an#!>DNA+

Dis,ussion:

!g$ prea'en3e o, 25)O*D !nu,,! 3!en37/%e,! 3!en37 4a ,oun% !n pa#!en# 4!#$

SLE )5.+.C* 4!#$ #a#!#!3a''7 !gn!,! 3an# %!,,eren3e a 3ompare% 4!#$ #$e3ompar!on group+ No ao3!a#!on o, !#am!n D !nu,,!3!en37/%e,!3!en37 4a oere%

4!#$ #$e 3'!n!3a' ar!a'e an% 'aora#or7 #e# #u%!e%+ T$e au#$or emp$a!Be #$e

!mpor#an3e o, %e#erm!n!ng 25)O*D erum 'ee' !n a'' pa#!en# 4!#$ SLE regar%'e

o, 4$ere #$e7 '!e an% #!me #o %!eae %!agno!+

1' APA-A7 7ASIL PENELITIAN TERSEB6T ALID8

1+ Apa&a$ #er%apa# ampe' 7ang repreen#a#!e %an %!%e,!n!!&an e3ara e'a pa%a

&on%!! 7ang ama / !m!'ar po!n# %a'am pera'anan pen7a&!# / 3oure o, #$e %!eae8

 Ya &arena mengam!' .@ pa!en

2+ Apa&a$ follow-up 'eng&ap %an 3u&up 'ama/ sufficiently long and complete8

 Tidak ada

-+ Apa&a$ %!guna&an &r!#er!a ou#3ome 7ang o7e&#!, %an #!%a& er!a8 

"+ ?!'a %!#emu&an ugroup %engan progno! 7ang e%a apa&a$ %!'a&u&an

a%u#men# un#u& ,a&#or < ,a&#or progno#!3 7ang pen#!ng8

 

II' APA-A7 7ASIL PENELITIAN INI PENTIN98

1+ ?aga!mana gamaran ou#3ome menuru# 4a&#u8

 T!%a& a%a

2+ Seerapa #epa# per&!raan progno! 8 

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III' APA-A7 7ASIL PENELITIAN INI DAPAT DIAPLI-ASI-AN8

1+ Apa&a$ pa!en %a'am pene'!#!an #ereu# erupa %engan pa!en a7a8

2+ Apa&a$ $a!' pene'!#!an meman#u %a'am &epu#uan pem!'!$an #erap!8

-+ Apa&a$ pene'!#!an erguna un#u& &one'!ng pa%a pen%er!#a %an &e'uargan7a8